Type 1 & low carb

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Once I made the link with my carb content and the size of the spike, which now seems obvious, and reduced to suit my needs life became a lot easier. I had fixed in my head stuff from the start where I was told eat whatever I want to and just match the insulin. It was only later , from others on here, that I picked up the idea of spikes, pre-bolusing and so much more.
 
As others have said, you can't duplicate results day after day, even with the same food and the same insulin. If you are within 2mmols of the previous day's result, that is a reasonable outcome.

Don't worry yourself about insulin resistance. It is not something you need to consider at this stage, if at all, unless you get significantly overweight and your insulin needs become very high... and I am talking about 15-20 units for every meal and 50+ units of basal. Any increase in insulin needs for you, particularly at the moment, is much more likely to be due to your beta cells dying off, so just accept that you will gradually need to increase your insulin doses during the honeymoon period although some people find they need to reduce them first and then increase them. It really is not something that you should concern yourself with at all, so please put it out of your head. You need however much insulin you need and it will change over time, sometimes up and sometimes down and you just have to learn to go with the flow.

Can you just remind us how long you have been diagnosed and been on insulin. I am wondering if you are just trying to do too much too soon. I know the feeling because I was really chomping at the bit to get it right straight away but it's like expecting to go and play in the Wimbledon final against Serena Williams when you normally play club level once a week. You have to set yourself reasonable expectations. It takes time and experience and practice and knowledge and you don't get that overnight. Be patient with yourself until things slowly click into place both with you getting the hang of it but also your body slowly stabilizing, because the honeymoon period can be pretty challenging.

One thing I do which helps with the timing of insulin and meals is to watch my Libre and not eat until I see the insulin starting to kick in and drop my levels. I have a rule were I don't eat if my levels are above 8 unless I really can't help it. So I inject for my food and then I keep a close eye on my Libre until I see my levels start to drop. Generally I like to be mid 5s when I eat but I would aim for mid 6s for yourself and that should still give you plenty of time for whatever you eat to hit your blood stream. So, if your levels are 8.5 when you inject for lunch, wait until they reach 6.5 before you start eating. If my levels are above 10 I can be waiting 2 hours to eat sometimes because high BG levels cause temporary insulin resistance. I know it isn't possible for everyone to wait 2 hours to eat a meal, but once you start keeping your levels mostly in range it becomes less of an issue.

I would also like to say that I learned almost everything I know from this forum and experimenting on myself, so don't expect too much from your clinic staff. As @Inka said, they can only ever make a best guess, so ultimately you need to learn how your particular body works in any given set of circumstances and adjust things accordingly. Gradually it takes up less head space and becomes more intuitive and I see it as more of a challenge and a game now rather than a serious health issue. Libre takes a lot of the strain out of managing my diabetes compared to finger pricking, but I wonder at this stage if it is giving you too much info and you seem to be applying Type 2 mentality to your results. If you were only finger pricking before your next meal, you would not know what your levels were 2 hours after your meal and therefore not be getting frustrated about them. If you were high at your next meal then you would just add a correction to bring you down into range. If you were consistently high at the next meal over a period of days then that might suggest that your basal insulin needed adjusting or that your ratio was wrong. You would look at the basal first and do a test by skipping lunch to see what happened in the absence of food and bolus insulin.

Just to give you an idea of the realities of diabetes and I am probably towards one extreme of the range, I often need 2 or 3 insulin corrections a day on top of my bolus for meals (although this is mostly for protein because I eat low carb) plus I need to adjust my Levemir (particularly my evening dose) on an almost daily basis sometimes. So last night I got a lovely flat line in the 5s with 2.5 units of Levemir, down from 3.5u the previous night. This afternoon for the second day in a row, I have been hedge cutting in my field and I will need to reduce it by another unit or perhaps1.5 units tonight. If I don't I will hypo. By contrast I need 22 units in the morning which is pretty consistent, unless I do lots of exercise on consecutive days and my basal dose is down to 0 at night and I am still hypoing overnight, so I have to start reducing the morning dose. When I am exercising less, the doses will go back up.
@Evergreen , there is a huge amount in this reply by @rebrascora that I can directly identify with and a few bits less so - just reflecting the reality that what works for one person doesn't necessarily work for everyone. Keep in mind that I am not T1 with the associated autoimmune circumstances - just someone with a missing pancreas!

I also watch my CGM and whenever possible I also don't eat if above 8, usually 7. Yes, this can be a real nuisance when dining with others and yes - despite people saying don't let your D dominate your life - in practice that is easy said and blatantly not possible! If I need to eat while still high(ish) I take extra corrective bolus. Before the readiness of CGM this was considered taboo - stacking insulin on insulin BUT thanks to CGM and timely alerts I can monitor and respond as necessary when necessary. I can't advise how much extra insulin - this is something you have to explore by trial and learning. Just start cautiously and keep notes! But as @rebrascora said trialling and testing really does gradually take up less head space.

I haven't fully read back so can't remember if exercise and activity has been emphasised in its effect on anyone's BG. I did a huge amount in the garden for a solid 9 hrs on Saturday and got an expected backlash of constantly falling BG. I worsened matters by doing more on Sunday, Monday and Tuesday. Now I'm really struggling to justify to myself the correctness of my bolus ratios because throughout each 24 hrs my CGM is alerting me to falling BG and I seem to be continuously "feeding" whatever insulin is inside me or "sugar surfing" to contain this dominant insulin. Yet I've reduced my bolus doses significantly - more than 50% these last 4 days - so the science of carb counting is temporarily overwhelmed by the "art" of guessing reductions. Thanks to CGM alerts this is a manageable nuisance from a self-inflicted set of circumstances. And the head space needed hasn't been difficult to find. Nor have the multitude of treats I've been rewarding myself with!

Very few days are similar. What I'm doing varies daily and not much is accurately predictable from one day to the next.
 
Sticking with low carb dinners going forward as the results speak for themselves (see attached graphs from yesterday and overnight).

So far, in addition to my original trial using shredded cabbage, I’ve now tried spiralised noodles made with courgette, cucumber and sweet potato.

In each case, a dinner under 40g carbs caused nothing like the post-prandial spikes I’ve become used to and evening/nighttime blood sugar has been almost flat.

I continue to be pleasantly surprised at how this experiment has turned out. 🙂
 

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Once I made the link with my carb content and the size of the spike, which now seems obvious, and reduced to suit my needs life became a lot easier. I had fixed in my head stuff from the start where I was told eat whatever I want to and just match the insulin. It was only later , from others on here, that I picked up the idea of spikes, pre-bolusing and so much more.
I have often seen posts and in the media that with T1 you can eat what you want and Bolus to match. That may be true for some people but as a generalisation it isn't true. You will almost certainly have to control the carbs.
 
I have often seen posts and in the media that with T1 you can eat what you want and Bolus to match. That may be true for some people but as a generalisation it isn't true. You will almost certainly have to control the carbs.
Without wishing to be contentious here, I personally think it is a fair (true) generalisation that you can eat what you want and bolus to match. It is the fundamental basis of a managed basal / bolus MDI regime. But (as with so much to do with managing D) it doesn't apply to absolutely everyone and certainly inappropriate for this thread of T1 & low carb. I would agree that one caveat should be - within reason. If one's general carb intake is, say, 50-100 gms per meal then a one-off hit of, say 200 gms of carbs won't necessarily be simply managed by just"extra" insulin. For all sorts of metabolic reasons.

I guess in the final analysis it is down to individual perspectives.
 
Sticking with low carb dinners going forward as the results speak for themselves (see attached graphs from yesterday and overnight).

So far, in addition to my original trial using shredded cabbage, I’ve now tried spiralised noodles made with courgette, cucumber and sweet potato.

In each case, a dinner under 40g carbs caused nothing like the post-prandial spikes I’ve become used to and evening/nighttime blood sugar has been almost flat.

I continue to be pleasantly surprised at how this experiment has turned out. 🙂

Think you've found your sweet spot pardon the pun, well done mate.
 
I have often seen posts and in the media that with T1 you can eat what you want and Bolus to match. That may be true for some people but as a generalisation it isn't true. You will almost certainly have to control the carbs.
No more than if I did not have diabetes.
It takes some work but over 80% TIR with a HBA1C of 40. I eat the same as my non-diabetic partner.
Reducing my carbs was harder for my lifestyle of lots of travel and lots of exercise.
It may not be ideal for everyone but that is why it is often said we are all different.
 
Apologies it’s been a while! I’m so pleased that low carb seems to work for you @littlevoice359!

I’m still struggling on (and wish I could say my profile was as flat as yours!). Had my appointment with the hospital and felt incredibly deflated afterwards, I don’t know what I was expecting but I really feel quite alone with this all.

I’m currently upping my basal which is something that I’m finding quite scary. I know that’s something to find my way through though. Hoping to get an appointment with the other hospital soon (I’m not expecting miracles but I’m hoping for a little more compassion/understanding of the psychological side to diabetes)
 
Apologies it’s been a while! I’m so pleased that low carb seems to work for you @littlevoice359!

I’m still struggling on (and wish I could say my profile was as flat as yours!). Had my appointment with the hospital and felt incredibly deflated afterwards, I don’t know what I was expecting but I really feel quite alone with this all.

I’m currently upping my basal which is something that I’m finding quite scary. I know that’s something to find my way through though. Hoping to get an appointment with the other hospital soon (I’m not expecting miracles but I’m hoping for a little more compassion/understanding of the psychological side to diabetes)
So, @Evergreen, while this is repeating a couple of points previously made by @rebrascora - I'll try to offer some perspective to this.

It is disappointing when a long awaited hospital appointment feels unsatisfactory BUT we are at risk of expecting too much from our Specialists. There are so many insulin dependent people, each often with quite different ways their D presents itself (and we frequently remind ourselves that we are all different in how we respond to our D management) I'm not so surprised that different DSNs have different approaches to how they advise their patients; and probably none of them are insulin dependent - so are working from theory more than personal experience.

Also, dare I say that all the while you can turn to the vast practical knowledge available from this forum - you aren't alone. If your questions weren't answered by rhe Hospital try asking here; we are happy to try and answer - but might confuse you with our own varied experiences!!

It is early days for you and D is extraordinarily complicated, confusing and contradictory (as described by Gary Scheiner in his book "Think Like a Pancreas"). So hang on in there, it will get a bit easier with time, we don't have (or expect to have) perfect answers right now and we ABSOLUTELY do have compassion and understanding of the psych side to D - many of us come face to face with that dilemna and somehow get through that challenge.

I hope your basal adjustment gives you a bit more stability. Scary as that is, your Libre should be a great help and do consider raising your alert level towards 5.6 to give you a bigger alert threshold and more time to consider a suitable response. Above all "Good Luck".
 
Hi @Evergreen

I will echo the messages above. Ask whatever questions arise. There are different approaches used by people on here, and whilst that can be confusing at times, they are all based on practical experience, and from these you may find something that helps you.

I think managing Diabetes is so different from many other conditions, where perhaps we can take a tablet and that is sorted. With this we are each making our own adjustments, whether it is to diet, insulin doses, levels of activity, …. It feels very different having that responsibility. You are in the early days and this idea takes some time to get used to.

I hope that your basal adjustment helped. Keep in touch and let us know how things progress.
 
Thank you @Proud to be erratic & @SB2015 !

I suppose it is early days for me, I just feel I’ve been struggling for such a long time without much noticeable differences. Your replies help me however by reminding myself it is difficult and yes very different to other illnesses. I don’t even really know what I was expecting from the hospital appointment, some relief maybe which they can’t really offer.

I think I do have some lingering questions/observations. I’m more and more aware that the anxiety I feel is holding me back in getting better control. This is what the hospital can’t help with and why these appointments are so frustrating.

I’ve recently been diagnosed with ptsd/trauma from lots of different thing coming together in this diagnosis. I’ve never been very anxious, but I’m now so intensely scared of going low (mainly at night), that upping my basal is so scary for me. The anxiety response is so visceral I cannot rationalise it at all. I know what to do when I go low, but it’s like I don’t trust my body anymore to actually respond?

The nurses at hospital just doesn’t understand this and I’m not expecting them to have any advice for this. I was just wondering if this is something that others have struggled with as well and what did you do to feel better?

I have upped my basal, but probably not quite enough yet. I’m waiting a couple days. I think the thing I’m worried about is still being in the honeymoon period (just) and therefore it’s more unpredictable. That worries me as I’ve had some very dramatic drops in the first couple months of insulin that lasted days.

This has turned into a bit of an essay! But I think it’s clear to me that I need to up my basal to give myself a better chance but I’m too scared and the nurses are pushing me, probably because my hba1c is going up and the risk of complications obviously worry me too
 
I am seeing a psychologist by the way, who’s talking about doing some EMDR when things have settled slightly more. So I’m hoping that will help
 
It is totally normal to fear hypos and nocturnal hypos in particular. What cured me was experiencing a week of them, when I started doing more exercise about 10 months into my diagnosis. I am on split dose Levemir and I reduced my evening dose after the first one but then still had one the next night. After 5 nights I was down to no basal insulin in the evening and still dropping ever so slightly into the red. I rang the clinic helpline but they weren't much help and I think that was the point when I realized that I live with this and I need to be self reliant. As a result of all those nocturnal hypos I also learned that I could trust my body to wake me up and I think that turned the corner for me and I started sleeping better because I had faced my demon and managed it well. I still get occasional nocturnal hypos 3 years later as my night time levels are very reactive to exercise the previous day and I have to be be very proactive in adjusting my evening basal doses, but I now with Libre alarms that helps a lot and I wake up, eat a jelly baby and I am back to sleep within a minute or two at the most...... which is naughty because I should stay awake for 15 mins to check I have recovered, but I guess that is a measure of how confident I am that my body will alert me if I need to treat it again. Before I was waking 2 or 3 times through the night to finger prick because I was so anxious. Now I sleep soundly all night and even if I drop into the red, it is really quickly and easily fixed and doesn't phase me at all. I also remind myself that non diabetics drop into the red a bit in the depths of the night sometimes so it is not unnatural, but obviously we have to guard against dropping too low and manage our basal insulin doses to balance things as well as we can to reduce that risk. It really was just a question of being forced to face my fear of nocturnal hypos and learn that I was quite capable of managing them, just like I do daytime hypos.
I am certainly not wishing nocturnal hypos on you, but accidental exposure to them was the answer for me and it is wonderful sleeping soundly all night long now! Hopefully just knowing that others have felt the same will make you feel a little better about your fear of them. It really is normal and understandable but I don't think it is easy for non diabetics to understand even DSNs, how impactful that fear can be. I think this is one of the reasons why I love Levemir so much, because it allows me to make these adjustments to my evening doses on a daily basis so I have more control over the situation. My basal the last few nights has been 3.5 units, 1 unit, 1.5 units 2.5 units and 1.5 units and apart from a very slight dip into the red on the night I just had 1 unit (I had done a lot of exercise that day) I have got it almost spot on, waking in the 4s or 5s most mornings! It has taken me 4 years to get to this level of adjustment though.
 
Thank you @Proud to be erratic & @SB2015 !

I suppose it is early days for me, I just feel I’ve been struggling for such a long time without much noticeable differences. Your replies help me however by reminding myself it is difficult and yes very different to other illnesses. I don’t even really know what I was expecting from the hospital appointment, some relief maybe which they can’t really offer.

I think I do have some lingering questions/observations. I’m more and more aware that the anxiety I feel is holding me back in getting better control. This is what the hospital can’t help with and why these appointments are so frustrating.

I’ve recently been diagnosed with ptsd/trauma from lots of different thing coming together in this diagnosis. I’ve never been very anxious, but I’m now so intensely scared of going low (mainly at night), that upping my basal is so scary for me. The anxiety response is so visceral I cannot rationalise it at all. I know what to do when I go low, but it’s like I don’t trust my body anymore to actually respond?

The nurses at hospital just doesn’t understand this and I’m not expecting them to have any advice for this. I was just wondering if this is something that others have struggled with as well and what did you do to feel better?

I have upped my basal, but probably not quite enough yet. I’m waiting a couple days. I think the thing I’m worried about is still being in the honeymoon period (just) and therefore it’s more unpredictable. That worries me as I’ve had some very dramatic drops in the first couple months of insulin that lasted days.

This has turned into a bit of an essay! But I think it’s clear to me that I need to up my basal to give myself a better chance but I’m too scared and the nurses are pushing me, probably because my hba1c is going up and the risk of complications obviously worry me too
Your anxiety is perfectly understandable, but difficult for others to know about as they think we simply count carbs and inject and that sorts it all out.

In the early days after my diagnosis I found it helpful to set an alarm for me to test at 3:00 am to ensure I was not having hypos in the night (no sensors available then) It reduced my anxiety about night hypos, and therefore meant that I went to sleep sooner and slept well, then woke up tested and then went back to sleep.

I found the pressure of not wanting to go high, worrying about complications, and trying to avoid hypos very difficult at the start. I set myself unrealistic targets and then couldn’t achieve them and then …. It does get easier and it is definitely impossible to get perfect results all the time. I saw it as a narrow road with uneven verges. Mine is now still a road but there are hard shoulders where we inevitably wander into.

People on here will understand your concerns so just keep asking questions. That is what the forum is here for.
 
Apologies if you have already answered this
Are you using a half unit pen. When you are sensitive to insulin this is so helpful, as you can make finer adjustments.
 
Thank you. I knew people on here would understand. I think you are right @rebrascora that it’s going to be a matter of facing my fears. I can’t even think about that at the moment though, it’s just such a strong physical feeling. Sometimes it’s completely gone and I’m ok, but then it just hits me (usually when something happens I hadn’t expected).

I’m trying to be rational about it (I can deal with it, my body will respond, I’m probably coming to the end of the honeymoon period so it’s less likely to happen again etc etc, but I’m finding it so intensely hard).

I think it’s coupled with this feeling of grief about what life could have been like. I’m finding it difficult to accept this is my life now and notice myself fighting it.

I’m sure it’s a matter of time, but I do worry that I’ll never get over the fear and that it’ll put me at serious risk of complications. It’s putting an extra pressure on to getting better control but then the other part of me is that very scared part of going low.
 
Apologies if you have already answered this
Are you using a half unit pen. When you are sensitive to insulin this is so helpful, as you can make finer adjustments.
I’m not on a half unit pen no. I’m on Abasaglar that doesn’t come in a half pen I don’t think.

I’m still thinking of requesting to go on levemir (with a half unit pen), but the nurses thought adding in another variable might increase my anxiety, which I understand. Not sure yet I agree with it though…
 
@Evergreen Your anxiety is normal - and very common. Until people have had a bad hypo, they don’t realise how scary they are. It’s completely natural to want to avoid them.

I agree that a half unit pen would help a lot. You could then make any increases in basal slowly and gradually, which would be less stressful. Levemir is a better insulin than Abasaglar in my opinion anyway. Abasaglar has the potential problems that Lantus does. Although any change can be nerve-wracking, I’d look at swapping to Levemir. In addition, if your hypo fear is crippling, then you could see if you’d qualify for a pump. The good thing about a pump is you never have a large depot of basal insulin sitting there, only tiny amounts of fast insulin. You can also programme it to match your needs much more closely. Pumps are really good for relieving fear of hypos.
 
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Hi @Inka, thank you.

I’m on the waiting list for a pump for this exact reason. At the new hospital I’m moving to they seem (at the moment anyway), a little more responsive to my fears and the consultant I’m seeing has said he wants me on a hybrid closed loop pump asap to have better control and hopefully less fear. From reading about it I really think it’ll help, but then the nurses say it might not and it makes me doubt myself again. I also know that even though the consultant is optimistic about getting a pump, the nurses are much more realistic and tell me it won’t be a fast process.

I asked about levemir at my appointment and linked it to my anxiety but they just told me they think the Abasaglar is actually working well for me, I just need more. But they didn’t really hear my anxieties around it I don’t think. I didn’t have a fight in me, but will bring it up with the new hospital team (I don’t think they use Abasaglar anyway).
 
I really can relate to all of those feelings and concerns. Diabetes is a balancing act and in the beginning it is really hard to find that balance, not helped by the honeymoon period (although for some people it smooths off the edges) and from not having the necessary experience ..... and confidence which I am sure is the biggest factor as with all things in life.....to manage things well at a time when it can be the most challenging. If only they could bottle and sell confidence! it would solve so many issues in life!
You really have to be kind to yourself and accept that you are doing your best in very difficult circumstances (especially with a young child to look after) and gradually it will become easier and you just have to hang in there for now and just keep doing what you are doing, until you gain more confidence and experience.

I do wonder if Libre is a bit of a curse in this as well as a blessing. If you didn't have it, you would not be even aware of those levels being up at 12 or 13 or whatever after lunch. Have you considered having a break from it for a week or two and just finger pricking. I used to do that occasionally when I started to feel frustrated and it gave me a break from the intensity of diabetes management and I came back to it refreshed after that break. I will confess that I felt horribly vulnerable the first night without Libre when I had breaks from it, but that would make me resent it all the more because "it" had mad me feel vulnerable and I would dig in my heels and show it I didn't need it! After the first night I would be fine and after a week I would come back to it with a new appreciation for it and how much easier it makes life.

It also helps me to remember that thousands of diabetics managed their diabetes without all this modern technology (including BG meters, not just Libre) and modern insulins and injector pens for decades. My uncle for instance was still going for a cycle ride on his own at 80 having been diagnosed in his 20s and he never had Libre. That provides me with an element of mental comfort that even when I am not doing as well as I would like, I am almost certainly still managing my levels much better than my uncle was able to do and yet he was still fit and active at 80.
 
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